Which specialty can make the most money with a decent lifestyle in Ontario over the next 30 years?

[jhenerose88]

Hi,

 I am a 3rd year med student planning to practice in Toronto and was wondering which specialty do you foresee being able to make the most money with a decent lifestyle over the next 30 years factoring in job market and where the healthcare system is going?

 

I am considering FM, Derm, Rads, but still open to anything.

[shikimate]

lol if you are still "considering" derm as MS3 you might be a bit late to the game.

[GH0ST]

1 hour ago, jhenerose88 said:

Hi,

 I am a 3rd year med student planning to practice in Toronto and was wondering which specialty do you foresee being able to make the most money with a decent lifestyle over the next 30 years factoring in job market and where the healthcare system is going?

 

I am considering FM, Derm, Rads, but still open to anything.

I can't help but chuckle a bit... one of these is unlike the other. 

- G 

[Findanus]

Psychiatry and radiology

[hero147]

Family med doesn't make that much for the work they put in and radiology isn't life style I think. 

 

Your best bet is derm. Start gunning hard. 

 

Edit: Though looking at the rads residents at my institution, they seem to be chilling when they're reading during the day. I assume they get killed on call though and by their enormous bookshelf. 

[rmorelan]

1 hour ago, hero147 said:

Family med doesn't make that much for the work they put in and radiology isn't life style I think. 

 

Your best bet is derm. Start gunning hard. 

 

Edit: Though looking at the rads residents at my institution, they seem to be chilling when they're reading during the day. I assume they get killed on call though and by their enormous bookshelf. 

yup it is misleading : ) - total hours per week for rads is just like anyone else - brutal - and the call shifts for rads are very frequent and equally brutal. 

and to made the point again - if it is not in general a lifestyle specialty anymore. It is like other fields "somewhat" controllable in that you can pick jobs that have various lifestyles. Right now I am on the upper end of busy (its NOT a competition, don't ever fall into that trap, but if you ask me right now how much I am working the semi-joking answer would be always and that is not far off. Including I suppose right now ha - those clinic studies aren't going to read themselves.) 

Derm is nice in that the income is pretty good but most importantly there is extremely little need for call. It isn't zero but it is as close to it as you can probably get in medicine, unless you are doing something really strange. 

 

 

[rmorelan]

3 hours ago, shikimate said:

lol if you are still "considering" derm as MS3 you might be a bit late to the game.

which just shows one of the weaknesses of the system - how on earth would anyone really know they wanted derm from the minute they started medical school? Not exactly a lot of time to get started on somethings.   

[jhenerose88]

3 hours ago, GH0ST said:

I can't help but chuckle a bit... one of these is unlike the other. 

- G 

Yea I realized. I have a few pubs and 1st authors in derm, but I’m pretty screwed compared to others who’ve been gunning since m1

[Pakoon]

28 minutes ago, rmorelan said:

which just shows one of the weaknesses of the system - how on earth would anyone really know they wanted derm from the minute they started medical school? Not exactly a lot of time to get started on somethings.   

I agree with this for the most part, but I do think there's a personal responsibility for students to seek out these competitive specialties and either rule them in or out early on. It's no secret that derm, optho or plastics is Uber competitive, and it's just the nature of these competitive specialties where demand far outweighs supply. It's unfortunate but most schools do give the opportunity for students to explore specialties way before clerkship.

[anonymouspls]

RADS is not a lifestyle specialty. Your life as staff is generally worse than your life as a resident. Brutal call, long hours. Upside is income (for now) and geographical flexibility. 

If you're limited to Toronto do family. If you're a bit more geographically flexible think about some IM subspecialties, Nuc med, Rad onc, Path. The further along I got in medicine the more I realized lifestyle >>>>> money. 

[jhenerose88]

12 minutes ago, anonymouspls said:

RADS is not a lifestyle specialty. Your life as staff is generally worse than your life as a resident. Brutal call, long hours. Upside is income (for now) and geographical flexibility. 

If you're limited to Toronto do family. If you're a bit more geographically flexible think about some IM subspecialties, Nuc med, Rad onc, Path. The further along I got in medicine the more I realized lifestyle >>>>> money. 

Thank you that's great advice. Are you saying stick with family for Toronto because of the limited openings in other specialties? 

[Pakoon]

7 minutes ago, jhenerose88 said:

Thank you that's great advice. Are you saying stick with family for Toronto because of the limited openings in other specialties? 

Family will be the only specialty that Will allow you to stay in Toronto, with decent certainty. This isn't always the case, but if you want to head your bets regarding matching to a primary area based on location, family medicine is the way to go.

[rmorelan]

On 4/13/2023 at 7:10 PM, Pakoon said:

I agree with this for the most part, but I do think there's a personal responsibility for students to seek out these competitive specialties and either rule them in or out early on. It's no secret that derm, optho or plastics is Uber competitive, and it's just the nature of these competitive specialties where demand far outweighs supply. It's unfortunate but most schools do give the opportunity for students to explore specialties way before clerkship.

I agree - although at least recently there has been extremely few opportunities to seek anything out I would say - COVID blocked a lot of stuff. Even prior - it is not as if you can instantly figure out these specialties anyway, and access is kind of hard to some of them perhaps in particular because they are so difficult to get into. For instance at Western there is no dermatology academic group (or at least wasn't when I was there). How exactly are you supposed to learn about the field there?

I have been struggling with figuring how schools could provide more access - there is a balance between seeing things and having enough of a background to even understand what is going on (there is a reason we have preclerkship rather than just going boom into clerkship ha). Schedules are already packed, there are a vast number of specialties to look at, and often schools spread out topics so you have wait quite a while to be taught the basis in some fields (something has to be in the later half of second year). It's not an easy problem 

 

Edited September 18, 2023 by rmorelan

[rmorelan]

39 minutes ago, Pakoon said:

Family will be the only specialty that Will allow you to stay in Toronto, with decent certainty. This isn't always the case, but if you want to head your bets regarding matching to a primary area based on location, family medicine is the way to go.

yeah it is by far the most flexible - as a rule the more competitive the field the more likely there are to be challenges in targeting a specific site. Particularly as many of those have fellowships which you basically have to take which further narrow things down (for instance it isn't usually a question of whether say there is a job in radiology in TO - it is whether there is a job for a MSK, IR, Body, Neuro, Chest, Cardiac, ER, Women's imaging, Pediatrics....... radiology job in TO, and you actually want that job when it pops up). 

[rmorelan]

I should add - you can make rads a lifestyle specialty - if you are willing to simply earn less. For instance you can go get a job at an outpatient radiology clinic reading US and plain films. There is no such thing as call, and your day ends when the techs leave as there is no more imaging done. You get all the holidays off, no pager and all weekends. You make a good living by most standards but it is probably less than 1/2 what a more hospital base rad gets - and all your skills outside of US and plain film will be gone in a few years limiting you to retraining in some painful way if you want back in (which is not easy to do). Like many things in medicine you can craft something that works for you if you are willing to pay the price. 

 

[anonymouspls]

45 minutes ago, rmorelan said:

I should add - you can make rads a lifestyle specialty - if you are willing to simply earn less. For instance you can go get a job at an outpatient radiology clinic reading US and plain films. There is no such thing as call, and your day ends when the techs leave as there is no more imaging done. You get all the holidays off, no pager and all weekends. You make a good living by most standards but it is probably less than 1/2 what a more hospital base rad gets - and all your skills outside of US and plain film will be gone in a few years limiting you to retraining in some painful way if you want back in (which is not easy to do). Like many things in medicine you can craft something that works for you if you are willing to pay the price. 

 

This is true, but at that point you have to think about why you are going into radiology. Are you going into rads to read ultrasound and plain films all day while making less than half of your peers? I was very interested in radiology and almost went into it for residency, and these were not the reasons I was interested, personally. At that point why not think about some of the other specialties that will offer you a similar if not better lifestyle, and better pay. Also as you said this is sort of like doing tele rads, once you get into it it's hard to get out and join a traditional practice. 

[Pakoon]

1 hour ago, rmorelan said:

I agree - although at least recently there has been extremely few opportunities to seek anything out I would say - COVID blocked a lot of stuff. Even prior - it is not as if you can instantly figure out these specialties anyway, and access is kind of hard to some of them perhaps in particular because they are so difficult to get into. For instance at Western there is no dermatology academic group (or at least wasn't when I was there). How exactly are you supposed to learn about the field there?

I have been struggling with figuring how schools could provide more access - there is a balance between seeing things and having enough of a background to even understand what is going on (there is a reason we have clerkship rather than just going boom into clerkship ha). Schedules are already packed, there are a vast number of specialties to look at, and often schools spread out topics so you have wait quite a while to be taught the basis in some fields (something has to be in the later half of second year). It's not an easy problem 

 

I think it definitely is possible though I'd imagine it is an uphill battle for anyone as you say. There is someone this year who matched to Toronto Dermatology from Western (not even the London campus!). They definitely had an impressive research portfolio, but this is definitely something to look into when it comes to deciding schools ( for those fortunate enough to have that option LOL).

[jhenerose88]

12 minutes ago, Pakoon said:

I think it definitely is possible though I'd imagine it is an uphill battle for anyone as you say. There is someone this year who matched to Toronto Dermatology from Western (not even the London campus!). They definitely had an impressive research portfolio, but this is definitely something to look into when it comes to deciding schools ( for those fortunate enough to have that option LOL).

wow it would be a dream to match Toronto derm. What are your thoughts on taking a research year between m3 and m4?

[rmorelan]

2 hours ago, Pakoon said:

I think it definitely is possible though I'd imagine it is an uphill battle for anyone as you say. There is someone this year who matched to Toronto Dermatology from Western (not even the London campus!). They definitely had an impressive research portfolio, but this is definitely something to look into when it comes to deciding schools ( for those fortunate enough to have that option LOL).

Ha it does happen - one of my classmates did it, although we had to bend so many rules to her unofficial elective time in TO to do it (had to do some serious begging to the admins on that one). You do what you have to do!

 

[1D7]

Short answer: Just do FM or IM. Guaranteed to find stable work in Toronto. This is what most people in your situation end up doing.

Long answer: The best lifestyle specialties are all outpatient-oriented since there aren't heavy ER/inpatient call burdens. That removes a lot of surgical specialties, radiology, and anesthesia. Of the remaining specialties that are still well-paid despite not having heavy ER/inpatient work, you're basically left with ophthalmology, cosmetic dermatology/plastics practices, and a few IM subspecialties. Assuming you haven't been gunning for them, you probably won't match to the most competitive specialties.

If you're willing to live like a resident for a few after becoming staff and put most your money away in an index fund/property, you're going to do just fine as a FM. Or do IM and down the road decide if you prefer shorter training or more training.

[jhenerose88]

58 minutes ago, 1D7 said:

Short answer: Just do FM or IM. Guaranteed to find stable work in Toronto. This is what most people in your situation end up doing.

Long answer: The best lifestyle specialties are all outpatient-oriented since there aren't heavy ER/inpatient call burdens. That removes a lot of surgical specialties, radiology, and anesthesia. Of the remaining specialties that are still well-paid despite not having heavy ER/inpatient work, you're basically left with ophthalmology, cosmetic dermatology/plastics practices, and a few IM subspecialties. Assuming you haven't been gunning for them, you probably won't match to the most competitive specialties.

If you're willing to live like a resident for a few after becoming staff and put most your money away in an index fund/property, you're going to do just fine as a FM. Or do IM and down the road decide if you prefer shorter training or more training.

What about taking a research year for derm? I have 4 pubs and a first author in derm. Lots of leadership and volunteer. A couple strong letters. But still feel a research year and getting connections could help me land derm?

[carmsprep1]

3 hours ago, jhenerose88 said:

What about taking a research year for derm? I have 4 pubs and a first author in derm. Lots of leadership and volunteer. A couple strong letters. But still feel a research year and getting connections could help me land derm?

People generally don't do research years for derm in Canada, unlike the US.

Your best odds are at your homeschool as some programs may already have  candidates in mind, or strongly favor those who had clinical exposure with their staff. By third year (and entering fourth?), you would really be banking on impressing during OOP electives. The timeline is a bit late for research and there are not many derm conferences that are still accepting abstracts.

[jhenerose88]

3 hours ago, carmsprep1 said:

People generally don't do research years for derm in Canada, unlike the US.

Your best odds are at your homeschool as some programs may already have  candidates in mind, or strongly favor those who had clinical exposure with their staff. By third year (and entering fourth?), you would really be banking on impressing during OOP electives. The timeline is a bit late for research and there are not many derm conferences that are still accepting abstracts.

Thanks. As a Canadian USMG, I may have to do derm in the US, would it be pretty easy to come to Toronto after residency? 

[carmsprep1]

7 hours ago, jhenerose88 said:

Thanks. As a Canadian USMG, I may have to do derm in the US, would it be pretty easy to come to Toronto after residency? 

No idea sorry

[indefatigable]

7 hours ago, jhenerose88 said:

Thanks. As a Canadian USMG, I may have to do derm in the US, would it be pretty easy to come to Toronto after residency? 

Yes - under the new CPSO rules you could do a Derm ACGME residency in Puerto Rico and as long you pass the US boards would be able to work in Ontario.  In other words, the Royal College no longer has effective control on medical licensing (at least in Ontario).

A hypothetical 3 year CMG could do GIM in the US and start working back in Ontario after 6 years of total training as IM staff; while future 4 year CMGs in FP will need 7 years of total training.